Medical Customer Service Representative Free
7 months ago
**Requirements**:
- Unity Health is a well-established primary healthcare provider in the South African market.
- Our mission is to offer primary healthcare insurance solutions to the vast majority of South Africans who are unable to afford medical scheme coverage.
- We have an opening for a Call Centre Nurse Consultant to join our Clinical team who will be the liaison between Unity Health, providers, and members.
**Responsibilities**:
- Duties & Responsibilities:
- Delivering a cost-effective Managed Healthcare service
- Effective Customer Service delivery
- Deliver an effective call centre service to achieve member satisfaction
- Responsible for incoming calls from Network GP rooms and members
- Clinically assess members and triage accordingly
- Where triage allows it, pre-authorise for physical GP consultation
- If triage does not allow a physical GP consultation, refer the member to the correct sub-category, for example, Intercare, Pharmacy Nurse Clinic, and Reality Wellness
- Manage clinical risk by promoting sound principles and strategies to decrease GP claims overutilisation
- Perform clinical audits on authorised GP claims and ensure the ICD-10 code(s) match the symptoms provided
- Classify and prioritise risks based on the frequency of member visits to a provider
- Ensure efficient Customer Service and compliance with agreed SLAs
- Manage and maintain data integrity and update accordingly where necessary
- Ensure all enquiries are resolved according to the business standard business rules while costing factors are maintained
- Ensure that all calls and cases are fully and clearly recorded on the MIP system accordingly
- Escalate any concerns or matters that will result in unsatisfied customer service
- Any other duties as assigned by your manager from time to time.
**Benefits**:
- Medical contributions
- Transport bonus
- Leaves
JOB TYPE
Work Day: Full Time
Employment type: Permanent Job
Salary: ZAR 98,000.00 Yearly
Positions available: 10
JOB REQUIREMENTS
Minimal experience: Unspecified
Gender: Indistinct
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